Patients with peripheral neuropathy present with weakness, numbness and/or tingling and pain in the upper or lower extremities or both. There are many causes for peripheral neuropathy. The most common causes for peripheral neuropathy are genetic mutations and diabetes.
For those types of neuropathies which are non-inflammatory, treatment is usually symptomatic, meaning focusing on the symptoms and removing the offending agent if possible. For example if a drug is causing the neuropathy, stop the drug or if diabetes is causing the neuropathy, control the diabetes.
However, peripheral neuropathy can also be caused by an underlying autoimmune disease. Up to 20 percent of patients with peripheral neuropathy actually have an autoimmune or inflammatory cause.
Quick identification and adequate immunosuppressive treatment of these patients helps prevent patient disability and sometimes death.
Therefore, when evaluating patients with neuropathies, the physician faces an important challenge of categorizing the disease as caused by an inflammatory neuropathy or a non-inflammatory neuropathy. Ascertaining whether the neuropathy is due to inflammatory vs non-inflammatory cause can sometimes lead to excessive testing, waste of health care dollars and, occasionally, harm to patients.
To solve this dilemma, our new research provides a simple strategy to quickly screen for inflammatory neuropathies.
Asking the following three questions, which highlight key characteristics of inflammatory neuropathies, prior to any blood work or other testing, can rapidly screen for potential inflammatory neuropathies:
1. Onset: how quickly did the condition present itself; did the symptoms of the neuropathy have a rapid onset and progress to reach their peak in less than eight weeks?
2. Distribution: how widespread throughout the body is the neuropathy; does the neuropathy affect one limb more than the other? Does it affect both the area near the body’s center and parts of the body located away from the center?
3. Systemic features: is the nerve pain accompanied by systemic features; in addition to the neuropathy, is the patient experiencing weight loss or skin changes?
If the answer to any of those questions is yes, then the patient has a high likelihood of inflammatory neuropathy and should be investigated and treated as soon as possible.
Chafic Karam, M.D., is the lead author of the paper “Rapid screening for inflammatory neuropathies by standardized clinical criteria,” published in the June 29, 2016 issue of Neurology® Clinical Practice.
In the interest of ensuring the integrity of our research and as part of our commitment to public transparency, OHSU actively regulates, tracks and manages relationships that our researchers may hold with entities outside of OHSU. Dr. Karam serves as Neurology® WriteClick® Deputy Editor and received speaker honoraria from Nufactor and consulting honoraria from Lundbeck. L.A. Tramontozzi III receives publishing royalties for Deja Review Psychiatry (McGraw Hill, 2007, 2011).